Outline

Background: Thymomas and thymic carcinomas are rare malign tumors of the mediastinum. We want to share our experience with the resection of advanced thymomas (Modified Masaoka stages IIIb and IV) that were admitted to our institution in the years 2000 to 2009.

Methods: A total of 20 resections have been performed on 19 patients with five cases of Masaoka stage IIIb (with invasion of great vessels; one was inoperable), 14 cases with Masaoka stage IV [four cases stage IVa (pleural metastasis) and 10 cases stage IVb (lymphogenous or hematogenous metastases)] as part of a multimodal therapy regimen.

Results: There were four cases (80%) of WHO type C and one case WHO type B3 in stage IIIb. The distribution of WHO types for stage IV thymomas was as follows: WHO type C in 47% (7 cases), A (2), B1 (1), B2 (2) and B3 (2) and B2/B3 (1). The size of the primary tumors ranged from 3 cm up to 25 cm. Completeness of resection was as follows: R0: 15, R1: 2, R2: 2 and one inoperable case. Thoracic incisions used: hemiclamshell: 8, median sternotomy: 4, thoracotomy: 6 and two cervical incisions. Two extrapleural pneumectomies were performed. Reconstruction of great vessels, pericardium or diaphragm with prosthetic material was a necessity in many cases.

Conclusions: In addition to neoadjuvant and adjuvant treatments (radiation therapy and chemotherapy), the surgery of metastases to spine, liver or brain was necessary to complete removal of the neoplasms. We will discuss our multimodal approach and follow up.